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Interview of Professor Paulus Kirchhof and Dr Huseyin Naci

The unique programme from the ESC and London School of Economics will help future leaders make difficult decisions in today’s complex healthcare environment

Cardiologists destined to become leaders in their hospital and in their specialty need to be equipped to answer difficult questions in an era one might term Big Cardiology. It’s an age in which quality is not just defined by whether a patient lives or dies, or their quality of life, but how hospital units and health systems perform and the degree to which practices are in line with clinical evidence and where optimal benefits for patients increasingly need to be achieved with limited resources. Economic endpoints are one of many key outcomes to consider within the bigger picture of taking decisions in healthcare.

Navigating this evolving landscape and making informed judgments is at the heart of a novel programme from the European Heart Academy of the European Society of Cardiology (ESC) and the London School of Economics and Political Science (LSE).The Master of Science (MSc) in Health Economics, Outcomes and Management in Cardiovascular Sciences kicks off in December 2015 with its first intake.

“The European Heart Academy and the ESC are delighted that we have teamed up with LSE to provide this forward looking programme for future leaders in cardiovascular medicine,” says Professor Paulus Kirchhof, head of unit for university courses at the European Heart Academy and the ESC’s academic liaison for the MSc. “People who want to become leaders in the field need to understand the academic principles that underpin the economic evaluation of cardiovascular medicine.”

Impact of cardiovascular disease on health economics

In the last 20 years, the prevention and treatment of cardiovascular diseases has prolonged the life of citizens in developed countries by around two years. “It has had a tremendous impact but it also comes at a cost,” says Kirchhof. “The MSc will help future leaders, e.g. those destined to lead a department, to decide what is most attractive and helpful for their patients. But most importantly it will enable them to communicate with budget holders on the same level.”Cardiovascular diseases cost countries in the European Union nearly €200 billion annually. Significant resources are consumed for disease prevention, detection, and treatment. In addition there are opportunity costs including foregone economic productivity associated with inability to work due to disability or premature death. Some patients may be able to stay in work and contribute to the economy but need expensive treatments to do so.

“It’s not necessarily how much we spend on treatments but how can we spend more wisely,” says Dr Huseyin Naci, assistant professor of health policy at LSE Health and a course director on the new MSc.

The big questions

Today's questions are complicated and the answers are complex too. The premise of the MSc is to equip participants with the tools and skills to make informed choices in a range of settings.The following types of questions will be addressed: How to ensure that therapy decisions are evidence-based? What is meant by evidence in clinical and economic terms? How to define quality in cardiovascular disease? How to measure outcomes to evaluate health programmes, policies, and interventions? How to identify, critically appraise, and use the existing evidence to inform clinical practice guidelines, resource allocation decisions, and policy development?Cardiologists are accustomed to examining clinical evidence and the programme will show where it stands in relation to economic and other types of evidence that contribute to decision making.Outcomes research which investigates clinical and economic endpoints will provide a broad framework within which these issues can be tackled.

Who the MSc is for

The MSc is aimed at cardiologists and others who focus on cardiovascular diseases in their day to day work such as those working in the pharmaceutical or medical device industries and government officials who could be policy makers or economists. It runs in parallel with the MSc in Health Economics, Policy, and Management, which is for similar professions but without the cardiovascular emphasis.The cohorts will have the opportunity to interact at social events in year one and take some of the same courses in year two. Discussions will provide different perspectives and fellow students asking difficult questions will prepare scholars for the real thing when they return to work.

How the programme is structured

The two year programme is executive style, enabling participants to continue working while they study. For the first cohort, taught components will be in London and comprise of two week blocks in December and June each year, amounting to a total of eight weeks.There are a number of compulsory courses:

Quality and outcomes in cardiovascular sciences gives an overview of health economics, outcomes research, and management in cardiovascular sciences.

Economic analysis for health policy describes the role economics can play in health policy and health system administration.

Systematic review and meta-analysis focuses on the principles of reviewing and synthesising the existing evidence to evaluate healthcare interventions.

“These courses are designed to provide participants with the foundations of health economics and outcomes research,” says Naci.

There are also optional modules from which students can pick and choose according to their areas of interest. Each student will have an LSE mentor to help them meet their personal aims for the programme.Most courses in the MSc will have a significant applied element, with lectures in the morning and interactive seminars in the afternoon.

Naci says: “Seminars will allow participants to discuss the points raised in the lectures and do hands-on analysis.”

Assignments will give more practice. For example, students will complete a cost effectiveness analysis for the economic evaluation course and conduct a meta-analysis for the systematic review and meta-analysis course.The climax is a dissertation which will apply much of what students have learned and ideally be based on real data from their workplace.

Naci says: “We expect that dissertations will address important decision problems facing participants in their own line of work, and lead to outputs that may be publishable in peer-reviewed journals.”

There may be opportunities to pool data with fellow students from other institutions and investigate differences and similarities.

Prospects after the MSc

Graduates will be in a position to accelerate their careers or refocus into related sectors such as hospital management, the pharmaceutical and medical device industries, consultancies, government and non-governmental organisations.

“Cardiologists with the MSc will have a stronger standing when they apply to leadership positions in cardiovascular medicine,” says Kirchhof. “But it will also open up new employment fields so that they could also consider working for healthcare providers and insurers, and in wider administrative roles within a hospital or larger healthcare provider group.”

How to get involved

The inaugural programme is open to 30 participants and starts in December 2015. Applications can be submitted at lse.ac.uk/cardioMSc. Expected fees are £11,000 per year. The ESC is offering maximum 15 scholarships covering tuition fees and prospective students can indicate if they want to be considered for a grant when they apply.